腹部抚触联合蓝光治疗新生儿黄疸的效果

目的观察腹部抚触联合蓝光对新生儿黄疸的影响。方法将156例正常的新生儿随机分成观察组和对照组,对照组采用蓝光照射,观察组在对照组基础上给予腹部抚触,其余的护理措施2组均相同。比较2组新生儿初次排便时间、胎便转黄时间以及黄疸指数。结果初次排便时间、胎便转黄的时间,观察组都比对照组早,差异有统计学意义(p<0.05)。经皮测定黄疸指数中对照组与观察组之间的差别无统计学意义(p>0.05),自第3天以后2组之间的差别有统计学意义(p<0.05)。结论腹部抚触联合蓝光能促进新生儿早日排完胎便,有显著降低新生儿黄疸指数和新生儿高胆红素血症发生的作用。     

抚触联合穴位按摩对新生儿黄疸的干预作用

摘要：目的 分析抚触配合中医穴位按摩的早期干预对新生儿黄疸的预防效果。方法 选取我院2019年5月至2019年11月期间收取的237例新生儿,分组采用方便抽样的方法,按不同干预方法分为两组,对照组132例,采用抚触干预;试验组105例,采用抚触联合中医穴位按摩干预;比较两组新生儿黄疸发生率。结果 试验组未发生新生儿黄疸,对照组新生儿黄疸发生率5.51%,差异有统计学意义（P<0.05）;试验组第3~5天经皮胆红素水平低于对照组,黄疸消退、首次排便及胎便转黄时间均短于对照组,每日排便次数多于对照组,24h睡眠时间长于对照组（P<0.05）。结论 抚触配合中医穴位按摩的早期干预可预防新生儿黄疸的发生,临床意义显著。     

抚触联合穴位按摩对新生儿黄疸的干预作用

目的：分析抚触配合中医穴位按摩的早期干预对新生儿黄疸的预防效果。方法：选取2019年5月~2019年11月收治的237例新生儿,按干预方法不同分为对照组132例和试验组105例。对照组采用抚触干预,试验组采用抚触联合中医穴位按摩干预。比较两组新生儿黄疸发生率、不同时间点经皮胆红素水平、胎便排泄情况及睡眠情况。结果：试验组未发生新生儿黄疸,对照组新生儿黄疸发生率为5.30%,试验组新生儿黄疸发生率低于对照组,差异有统计学意义（P＜0.05）;试验组第3~5天经皮胆红素水平均低于对照组,黄疸消退、首次排便及胎便转黄时间均短于对照组,每日排便次数多于对照组,24 h睡眠时间长于对照组（P＜0.05）。结论：抚触配合中医穴位按摩的早期干预可预防新生儿黄疸的发生。     

蓝光灯照射配合抚触治疗新生儿黄疸的疗效观察

目的 为了观察新生儿接受蓝光灯照射治疗新生儿黄疸的效果。方法 将2000年4～11月出生需要照射蓝光灯的新生儿随机分为抚触组与对照组各10例,抚触组在输液,照灯的前、中、后期分3次进行抚触,每次15min,对照组未进行皮肤抚触。结果 抚触组婴儿平均每天摄入奶量、大小便次数均较对照组多(均P<0.05),而新生儿皮测黄疸指数、哭闹时间、恢复时间均较对照组少(均P<0.05)。结论 蓝光灯照射配合抚触治疗新生儿黄疸,有利于新生儿黄疸的恢复,缩短了治疗过程。     

舒适护理联合抚触干预在新生儿黄疸中的应用及有效率分析

目的 探讨舒适护理联合抚触干预在新生儿黄疸中的应用及有效率。方法 选取 2020 年 8 月至 2022 年 8 月期间本院收治 的 300 例新生儿黄疸患儿作为研究对象。按照随机数字表法将患儿分为对照组和观察组,每组各 150 例。对照组实施常规治疗 及舒适护理;观察组在对照组基础上联合抚触干预。观察对比两组的血清总胆红素、间接胆红素水平,症状体征消退时间（首 次排便时间、胎便转黄时间、黄疸消退时间）以及治疗总有效率。结果 干预后,观察组的血清总胆红素、间接胆红素水平均 显著低于对照组（P<0.05）。观察组的首次排便时间、胎便转黄时间、黄疸消退时间均比对照组显著缩短（P<0.05）。观察组的 治疗总有效率显著高于对照组（P<0.05）。结论 将舒适护理联合抚触干预应用于新生儿黄疸的护理中,可降低患儿的血清胆红 素水平,促进胎便排出,加快黄疸消退,提高治疗有效率。     

综合护理干预在新生儿黄疸患儿中的应用

目的:探讨综合护理干预在新生儿黄疸患儿中的应用效果。方法:将90例新生儿黄疸患儿采用随机数字表法分为观察组和对照组各45例,均给予蓝光照射治疗,对照组采取常规护理,观察组在此基础上实施综合护理干预;比较两组疗效。结果:观察组治疗3 d、5 d后黄疸指数均高于对照组(P0.05),新生儿首次排便时间和胎粪转黄时间均少于对照组(P0.05),每日睡眠时间多于对照组(P0.05),皮肤损伤、呕吐、闷热综合征和过度换气等不良反应的发生率均低于对照组(P0.05)。结论:联合护理干预蓝光照射治疗,可有效减轻新生儿黄疸患儿黄疸程度,降低不良反应的发生率,具有较好的临床应用价值。     

早期综合护理干预对新生儿黄疸的影响

目的:探讨早期综合护理干预对新生儿黄疸的影响。方法:将160例剖宫产正常足月新生儿随机分为干预组和对照组各80例,两组新生儿均进行早接触、早吸吮,实行母乳喂养、母婴同室、按需哺乳、常规新生儿护理,干预组在母乳喂养的基础上按需添加奶粉,结合抚触、游泳护理,观察记录新生儿每日黄疸指数、第1次排胎便时间及转黄时间。结果:干预组新生儿黄疸指数低于对照组(P<0.05),干预组新生儿第1次排胎便时间及转黄时间较对照组提前(P<0.01)。结论:早期综合护理干预能降低新生儿黄疸指数,减轻生理性黄疸程度,减少病理性黄疸的发生。     

灌肠配合抚触对早产儿黄疸的早期干预研究

目的：探讨清洁灌肠配合抚触对早产儿黄疸进行早期干预的效果。方法：将我科50例早产黄疸患儿随机分为两组,对照组25例采用常规治疗（保温＋蓝光治疗等）,实验组25例在常规治疗的基础上行少量温生理盐水清洁灌肠配合抚触治疗,每天1次,连续3～5d。观察两组患儿每天排便次数及胆红素下降水平。结果：实验组胆红素水平比对照组下降明显,排便次数多,胎粪转黄的时间缩短,两组比较有显著差异（P〈0.05）。结论：清洁灌肠配合抚触早期干预有利于降低早产儿病理性黄疸的发生率,防止核黄疸的发生。     

抚触对新生儿排便和黄疸的影响

目的:探讨抚触对新生儿排便和黄疸的影响。方法:将足月分娩的300例正常新生儿随机分为抚触组和对照组各150例,抚触组在新生儿娩出24h内开始给予抚触,对照组不予抚触。观察两组首次排便时间、胎便转黄时间、高胆红素血症的发生率。结果:抚触组首次排便时间、胎便转黄时间及黄疸消退时间均比对照组提前,高胆红素血症发生率亦显著低于对照组(P<0.05)。结论:新生儿抚触能加速胎便排出,使胎便转黄时间提前,减少肠肝循环,降低高胆红素血症发生率。     

基于蓝光治疗的三联序贯护理在新生儿黄疸康复中的应用

目的:观察基于蓝光治疗的三联序贯护理在新生儿黄疸康复中的应用效果。方法:选择2020年10月—2021年9月收治的新生儿黄疸90例为研究对象,按随机数字表法分为对照组、观察组各45例。两组均行蓝光治疗,对照组采取常规护理,观察组采取基于蓝光治疗的三联序贯护理干预。比较两组护理前后黄疸指数及血清间接胆红素变化情况、新生儿首次排便时间、胎便转黄时间、黄疸消退时间、不良反应发生情况。结果:观察组新生儿黄疸指数及血清间接胆红素水平低于对照组,首次排便时间、胎便转黄时间、黄疸消退时间短于对照组,不良反应发生率低于对照组(P<0.05)。结论:基于蓝光治疗的三联序贯护理应用于新生儿黄疸护理中可促进新生儿黄疸症状消失,减少不良反应的发生。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.